Treating knee injuries such as torn ligaments, fractures and dislocations
Knee injuries are among the most common type of injuries treated by physiotherapists on the Northern Beaches and are also at the top when it comes to re-injuries. I don’t know how many times I’ve seen a patient who ended up having a serious knee injury and they said they just tried to ‘run it out’. If you are involved in physical activity or sports such as netball, volleyball, beach volleyball, soccer, AFL and rugby league, you are at a much higher risk of suffering a serious knee injury compared to the rest of the population. If you are suffering from pain or swelling in the knee, please don’t try and run it out, jump in the car and head down to your local Northern Beaches physio for some hands on treatment and get a plan for recovery so you don’t end up suffering ongoing pain or movement issues.
These are the most common types of knee injuries treated by musculoskeletal physiotherapists:
Torn ligaments and ligament strains
Like a lot of musculoskeletal injuries, it’s the most active people who get the wrong end of the stick when it comes to suffering them. Your knee contains a number of ligaments connecting bones to other bones in and around the knee joint that are susceptible to damage when you take a sharp change in direction, land wrong from a jump, or commonly from force directly to the knee, such as in soccer or footy tackle. The knee is made up of 4 ligaments that can all be torn or strained:
ACL – The ACL is the big daddy of knee injuries, the most painful and also the most common. The ACL connects the thigh bone to the shin bone and is most likely to strain or tear when pivoting or landing from a jump, around 80% of ACL tears are non-contact injuries.
PCL – The PCL is there to stabilise the tibia and prevent it from being bent too far backwards, commonly tearing or becoming strained due to forced hyperextension. It is the least common of the knee injuries, accounting for around 10% of them in total.
MCL – Your MCL is located on the inner side of your knee and connects the medial femoral condyle and the medial tibial condyle. MCL injuries usually take place during a sharp change in direction, when the knee is twisted while your foot stays in place, landing incorrectly from a jump, or from a hard direct hit to the knee, commonly in a footy tackle.
LCL – Like the ACL and MCL, your LCL helps control the sideways motion of the knee, connecting your femur to the fibula. LCL injuries only account for less than 5% of knee injuries, but they are known to be pretty darn painful.
Once your physio has conducted a thorough physical examination, they will be able to give you a good idea of the grading of the injury (1 being the lowest, 3 the highest) and begin treatment. Depending on whether you have suffered a strain or a tear, you may be required to undergo surgery and your physio will be able to design an in-depth prehab and rehab program for you that will aim to:
- Reduce pain and swelling
- Return the joint to its full range of motion
- Strengthen the area surrounding the knee such as hamstrings and quadriceps
- Improve your proprioception, agility and balance
- Improve your technique and function specific to any sports or your circumstances
- Get you back into your sport, regular activities and exercises
- Minimise your chance of re-injury
Fractures and dislocations
Musculoskeletal physiotherapists commonly see knee fractures and dislocations paired with ligament damage, they tend to go hand in hand unfortunately. Not only are patellar fractures relatively common, they are also painful and can take a good deal of healing time. A patellar fracture is a break in the patella, or knee cap which is a small bone sitting at the front of your knee. The knee cap acts like a shield for your knee joint and is vulnerable to fracturing if you fall directly onto your knee or cop a big hit in sport or commonly in a car crash.
A patellar fracture may be a clean and even two-piece break or the bone can break into many pieces (ouch). If you are lucky enough when suffering a patellar fracture and the pieces of bone are not displaced, you may not need surgery.  Because treatment for a patellar fracture includes a period of time where you need to keep your leg immobilized in a cast, it’s not uncommon for your knee to become stiff and your thigh muscles to shrink. During the rehabilitation your physiotherapist designs, will be given a number of specific exercises to help improve the range of motion in your knee, strengthen your leg muscles surrounding the knee cap and manual therapy in order to decrease stiffness.
The most painful part of dislocating the patella is the immediate time after; with most people having a sort of relief in the hours after it is re-located. Because a dislocation or fracture commonly occurs with a ligament strain or tear, your rehabilitation will take at least 8 to 12 weeks to successfully heal the area and decrease your chance of a recurrent dislocation.
If you have:
- Sudden or severe pain in the knee
- Heard a loud pop or snap during sport or exercise
- Swelling in the knee after feeling pain
- A feeling of looseness in the joint
- An inability to put weight on the joint without pain, or any weight at all
Get down to your local physio ASAP. You’re only doing yourself further damage and increasing your chances of re-injury by putting it off.
 Schuett DJ, Hake ME, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ. Current treatment strategies for patella fractures. Orthopedics. 2015;38(6):377-84.